黃斑裂孔第3、4期視網膜內界膜染色輿剝除的前瞻性研究

A prospective study of staining and removal of retinal internal limiting membrane in stages 3 and 4 macular holes

doi：

摘要：

目的 爲了確定用吲哚青綠介導特發性黃斑裂孔第3、4期視網膜內界膜剝除手術的解剖和視覺效果.方法連績研究3～4期特發性黃斑裂孔病人28例28祗眼.所有眼都施行平部玻璃體次全切除術,必要時清除後部玻璃體及任何可見的視網膜前膜.將濃度爲每毫升0.25mg至1.25mg的ICG溶液緩慢地注入到黃斑,待浸漬時停止.內界膜被染色,距黃斑裂孔邊緣1～2個視盤直徑環行剝除內界膜.手術結束時使用12%Perfluoropropane(C3F8)氣體.術後病人需要保持面朝下2周.結果 隨訪時間爲6～14個月,平均9.5個月.14祗眼(50%)為黃斑裂孔第4期,另14祗眼(50%)爲黃斑裂孔第3期.11祗眼(39.3%)爲1年以上的慢性黃斑裂孔.最後隨訪時25祗眼(89.3%)解剖復位,黃斑裂孔閉合.其中21祗眼(75%)黃斑裂孔封閉,另4眼(14.3%)黃斑裂孔變平.18祗眼(64.3%)視力提高兩行或兩行以上.視力平均提高2.6行(範圍2～7行).非慢性裂孔和慢性裂孔分別提高3.4行和1.4行.經統計學處理,兩組間具有顯著性差異(P=0.031).結論 ICG介導視網膜內界膜剝除在封閉特發性黃斑裂孔第3～4期中是很有幫助的.

Abstract：

Objective To determine the anatomical and visual outcome in primary surgery for idiopathic stage 3 or 4 macular holes with indocyanine green (ICG)-assisted retinal internal limiting membrane (ILM) peeling. Methods A prospective consecutive study of 28 eyes of 28 patients with primary idiopathic stage 3 or 4 macular holes was conducted. All eyes underwent a subtotal pars plana vitrectomy with removal of the posterior hyaloid and any visible epiretinal membrane when necessary. ICG solution of concentration ranging from 0.25mg/ml to 1.25mg/ml was gently injected over the macular region with the infusion temporarily stopped. The ILM was stained and removed in a circular fashion 1～2 disc-diameter from the edge of the macular hole. At the end of the surgery, 12% perfluoropropane gas was used and patients were required to maintain a facedown posture for two weeks postoperatively. Results The mean follow-up duration was 9.5 months (range, 6～14 months). Fourteen (50.0%) eyes had stage 3 macular holes and the other fourteen (50.0%) eyes had stage 4 macular holes. Eleven (39.3%) had chronic macular holes of duration more than one year. At the last follow-up, twenty-five (89.3%)eyes had successful anatomical closure of the macular hole. These included twenty-one (75.0%) close macular holes and four (14.3%) flat macular holes. Eighteen (64.3%) eyes had improvement of two or more liues of visual acuity. The mean improvement in visual acuity was 2.6 lines (range,-2 to 7 lines), with 3.4 liues and 1.4 lines for non-chronic and chronic holes respectively. This difference was statistically significant (two-tailed t test, P= 0.031). Conclusion ICG-assisted retinal ILM removal appears beneficial in closing primary idiopathic stage 3 or 4 macular holes.``

作者：	郭坤豪[1]賀澤烽[2]
Author：
作者單位：	中國香港中文大學眼科及視覺科學學系及香港眼科醫院;香港瑪麗醫院眼科 中國香港東華東院眼科部
期 刊：	美中國際眼科雜志   ISTIC
Journal：	U.S. CHINESE JOURNAL OF OPHTHALMOLOGY
年，卷(期)：	2001, 1(4)
分類號：	R77
關鍵詞：	吲哚青綠    內界膜    黃斑裂孔期
Keywords：	Indocyanine green Internal limiting membrane Macular hole Stage
機標分類號：	R77 R81
機標關鍵詞：	黃斑裂孔    視網膜內界膜    染色    內界膜剝除    前瞻性研究    internal limiting membrane    visual acuity    macular hole    pars plana vitrectomy    epiretinal membrane    indocyanine green    visual outcome    吲哚青綠    隨訪    解剖    次全切除    玻璃    病人    性差異    溶液
基金項目：